Podcast 174: The Truth About Carbs

Rebecca Scritchfield, RDN: 0:02

This episode is brought to you by Self-Care for Diabetes, a virtual online program that's doing diabetes care differently.

Glenys Oyston, RDN: 0:10

We don't tell you to lose weight. Instead, we help you create positive and meaningful changes that make your life with diabetes better than before. Visit selfcarefordiabetes.com to learn more.

Rebecca Scritchfield, RDN: 0:21

Hey, Glenys. How you doing?

Glenys Oyston, RDN: 0:23

Hey, Rebecca, I'm doing well. How are you?

Rebecca Scritchfield, RDN: 0:25

Oh, I am just peachy. And you know, peaches have carbohydrates and sugar. They're delicious fruit I love and yeah, an excellent segue to our topic today.

Glenys Oyston, RDN: 0:43

Yeah, we're going to be talking about carbs. Because I feel like that is the number one food that everybody stresses about when they get a diagnosis of pre-diabetes or diabetes. I think it's a food that seems to have the most misconceptions surrounding it when it comes to eating for diabetes.

Rebecca Scritchfield, RDN: 1:03

Yeah, there is a lot of confusion. And, you know, as dietitians it can sometimes feel, obviously, we go to school for forever and do an internship. And we learned so much about food that we can almost forget sometimes how overwhelming it can be for folks. And even some of the simplest things like I'm thinking about one of our group members, who on our recent live chat had talked about how one of her favorite things to have at breakfast was these cheesy eggs and that she was avoiding it thinking that it was raising her blood sugars. And she was having some morning highs which can happen, you know it and is usually pretty common. But she was attributing it to the cheesy eggs, versus just the way her body was working. And so when we realized, oh, she might not understand that eggs don't have carbohydrates, and that it would be normal anyway for your blood sugars to rise at certain times or to rise and fall around eating patterns. And so it was that level of confusion around what is a carbohydrate? What does it do? What foods contain carbohydrates? And how much should I even be thinking about this stuff? And so, it can be really overwhelming for people. I hope that we can help make it clear with some serious myth Fbusting.

Glenys Oyston, RDN: 2:21

Yes, absolutely. And I wish people didn't even have to know what carbs are. But, you know, it is helpful when it comes to sort of managing your blood sugars.

Rebecca Scritchfield, RDN: 2:31

Well, I know when we were talking about planning our program that we're just like, no, we're just only going to talk about food. Because people don't eat nutrients, they eat food. And then you realize, well, people are confused about this. So we meet everyone where they are. But that is one of my first tips is to let's think about the bigger picture about eating patterns and food. But for today, and for parts of our program, we do go into the nitty gritty and talk about nutrients and carbohydrates.

Rebecca Scritchfield, RDN: 2:59

So, the first myth that I wanted to present for conversation is about low carb eating. And this belief that we know is very common and very popular. And the myth is that low carb eating is the best way to eat for diabetes, you know, it's superior, right to any other way out there that you could eat.

Glenys Oyston, RDN: 3:22

Yeah, and I just want to say to anybody who is really enjoying their low carb diet out there, like this isn't to say your diet, or your eating pattern isn't the right way, that if, you know, we're all for whatever works for people. But we also have people coming into our program that are super stressed about I've been told I need to eat low carb, I've already done that it didn't work, it sent me into major overeating and binge eating, or I just couldn't maintain it. And so I think it's important to talk about that there are other ways to eat, that can just as well manage blood sugars that are maybe more livable for a lot of people. And so you know, the reality is, even if you ate no carbs, your body still needs to run on carbs preferentially. It can run on other things, like ketones, right? But that's hard to get into ketosis. And, you know, really restrictive to have to do that. So your body loves to run on carbs, it stores carbs, it will release them from the storage and liver and muscles to make energy or to you know, use the energy and it'll make its own energy if it needs to come from carbs. So, you know, I think the big problem is this idea that we're just not supposed to have carbs at all, ever. And what I see more as the problem is really the pattern that people tend to eat in that they'll kind of like skimp on carbs all day. And then at the end of the day, their body is like give me energy and they eat like a really large meal and so your blood sugar's kind of you know just scutting along, kind of low level all day, and then all of a sudden it gets a lot of carbohydrates, and it shoots way up. And that's just kind of hard for your body to handle. Especially if you've got insulin resistance going on. So what we're really looking for is this sort of slower and less steep rise at just intermittent times. And, Rebecca, tell me, how do we make that happen if we're eating carbohydrates?

Rebecca Scritchfield, RDN: 5:30

I really hope that people feel that they can eat the foods that offer carbohydrates, and enjoy them and really feel like, you know, this is satisfying, because I'm eating foods that I like, and I'm nourishing my body. You know, I think that's a great positive attitude. One of the things that you can do when you're considering the foods that you like, that have carbohydrates, so for example, it could be potatoes or breads, it could be various fruits, like I mentioned peachy in the beginning, I also like watermelon, I actually like all kinds of fruits. Your favorite fruit, you insert that there, that we want to remember that those foods contain fiber. And fiber rich foods can be really helpful with working with your body on regulating blood sugar levels, and then foods that offer fats and protein as well. And fats might be something that you use that help those foods taste nice and yummy. So it could be some butter or oil or, you know, crunchy almonds, that's part of a yogurt, it really just depends on the types of foods that you like. But when you know that those have fats and know that fats and proteins don't tend to make your blood sugars rise, but in combination with the carbohydrate foods, you tend to get a more slower and more stable rise, more lasting energy. And I would add overall, a more satisfying meal.

Rebecca Scritchfield, RDN: 7:03

So if you stop and think about what types of meals you typically like to enjoy and snacks you typically like to enjoy, there's a good chance that it already delivers some amount of combination. Or you could stop and think, I wonder what's one thing I could add in that might help with that combination. So there's a lot of cool, interesting, fun experiments that you could do with creating this meal mix and focus on taste, pleasure, and this knowledge and wisdom that not only are you going to enjoy your food, and it's going to help give you energy to do things you care about, but it's also giving you things that really help your body feel good. And, you know help you get things done in your day, which at the end of the day, what's our typical thought like? What's my checklist? Can I get it all done? We need energy to do that, that means we need food. And the meal mix is really helpful that with a variety of the ingredients.

Glenys Oyston, RDN: 7:58

Yeah, and I like what you said about satisfaction. Like in the end you have to be satisfied by this meal. And if somebody is very satisfied by their low carb meal, they never have sort of this rebound eating. so be it you know, that's great for that person. Other people might say I'm just not satisfied, and I'm searching for more all day. So what we kind of tend to teach is more along the lines of what they call consistent carb, I think. We teach that meal mix. I think that's the most important thing that people learn that if you combined foods that gives you that nice, even slower blood sugar rise that gets you through the day to get that checklist done. And I don't mean like consistent carb like measuring, you know, and weighing foods, it's more like you just eyeball your meals, and you're kind of aiming for a very similar amount of carbs through the day, Concentrating on that meal mix. And you're just instead of getting those big blood sugar spikes, you're getting more even rises. So those are just two ways we've talked about to eat. I think there are probably other ways that people have found to manage their way of eating. But just this idea that low carb is the only way. If that's not doable for somebody that's just, it's not going to work for them. And they're going to give it up and then it can go back to chaos if that's sort of where they started from.

Rebecca Scritchfield, RDN: 9:26

Exactly. And I wanted to offer one more tip before we move on to the next myth. Because you said the word ketosis and I'm sure people are like keto, and hopefully the word keto did not come to your brain, and now I've just interjected it in there. But I really do have to say this briefly. Glenys you're 100% right. that it is difficult to get to, to maintain. But the other thing about that again, because we're on this myth that oh, it must be superior, besides the difficulty of it, just grit, just try harder actually not necessarily true because what the research shows is that when you follow folks, even two years after keto, any short-term benefit that it had with blood sugars and diabetes went away after two years. So if you plan to have a nice long and happy life with diabetes, it really does not look like in the research that keto is going to do it for you. So, again, it's like even low carb is a little bit more flexible than keto. There's a lot of extreme stuff I just hope people decide not to do.

Glenys Oyston, RDN: 10:34

Right, exactly. What you have to focus on, is this doable for me? Can I do this long term? And do I enjoy it?

Rebecca Scritchfield, RDN: 10:44

Cool. Okay, so next myth: you have to give up sugar when you have diabetes. You know, what is interesting to me about this is that sugar is pretty much even in regular sort of diety culture, it's pretty much been the enemy. Fat became famous. Sugar became the enemy. And so you can see this perpetrated a lot, even with the American Diabetes Association, and other really large and trusted organizations. But you've got to go a little bit deeper. So, if you have the right support system, if you go a little bit deeper with the American Diabetes Association, they talk about personalizing nutrition to help you meet your needs. And I would just love to hear you share a little bit more about the problems people can face when they're trying to give up sugar, right? If sugar is bad, I gotta give it up. What is the problem with that?

Glenys Oyston, RDN: 11:39

Right. I mean, we can admit that probably you could live your whole life and not have sugar in the form of just how we think of like table sugar, or that kind of thing. But the truth is, it exists. It's pleasurable. We've had it, it tastes good, we like it. And I think that most people cannot successfully avoid sugar all the time. And I think that's the extreme that people go to. That, I really just have to avoid all sugar. And the truth of it is we usually kind of do this disinhibition thing, we're like, well, we can do it for a while, and then all of a sudden, we become the Cookie Monster. And they're like, no, I have to have all the cookies right now. And that is something so common that we see all the time. You know, the people that we're working with in our program, they've all tried some version of that, and it just didn't work. They couldn't maintain that restriction, and they kind of end up feeling very out of control around sugar at some point. And so, I think, instead, looking at a way, how can we include sugar in our world? You know.

Rebecca Scritchfield, RDN: 12:52

Yeah, definitely. I love the idea of this radical acceptance of hey, sugar is here and you know what, it tastes good. And again, every listener is going to have their own oh, I'm more of a, you know savory, salty person. That is great, but starting with the realm of where your true preference is, I think is really, really helpful. The other thing that you might ask yourself is, if I reflect is there an eating pattern around sugar where part of my challenge is I'm busy and things around thinking about food and meals and grocery shopping, they end up going by the wayside. And so when I lose that time to plan I feel pretty lost, and so the chaos in my eating has to do with this kind of catches, catch can, I'm getting whatever I can eat for quick energy and where, that has been a struggle for folks. People have gotten really like, oh, I gotta read the label and every little ingredient, they might have researched or heard a little bit something about how added sugars and you know just a quick point of clarification. There is, we talk about sugar and fruit, if you peel banana, eat banana, there's sugar there that you're not going to take out and that would be sort of sugar that exists naturally. And another one people don't really think about is something like milk there is, lactose, a sugar in milk and you don't get rid of that sugar, it exists there. And so when you have a food and sugar is added and it's usually for a culinary benefit, a palatability and pleasure benefit, it helps add sweetness, people enjoy it and that would be added sugar. And I kind of think when they say well, be more mindful of added sugar, part of what they're thinking about is something like the idea that a lot of people think they have to cut out fruit, whereas fruit is actually associated with positive health and positive diabetes outcomes. And so that's great. But that also does not mean never have added sugar again.

Rebecca Scritchfield, RDN: 15:13

So like the way that I started this tip, you really want to think about your personal preference, and what's meaningful. Are there any other behavioral problems or life problems that are kind of getting in the way of your day-to-day food choices, I would investigate there. And that level of mindfulness can then bring you back to okay, is there anything that I might want to be aware of, if I'm not going to eliminate because that doesn't sound good. We're also not saying, hey, if you're in our group, you're not allowed to change anything, right? We want to encourage positive and workable changes. And so I'm just going to use an example because we eat it every day in our house, but it's something like Nutella, right? You love it, and you have it. How do you like to enjoy it? Do you like it with banana on a piece of wheat toast? Do you like it stirred into a yogurt? Do you like some of it on the spoon, as part of an afternoon snack? And you know, that if you think about the context of pleasure, of how would I like to enjoy. A lot of the times what you would describe as a context is workable, if you feel you have a healthy relationship to food, you're just trying to be a little bit more flexible. And that would be what we would guide you to do. If you certainly are dealing with an eating disorder, eating disorder history, or where you're at in coming off of chronic dieting, and you're working on your relationship to food, and you just have certain foods that feel very emotionally overwhelming if you think about eating them. That is something that we support you in our group for, we would encourage you to work with us, you get discounts to work with us one on one if you want, when you're in our group, or work with your current care team, and work on the relationship with food, because in a lot of those cases it's actually not about the food or the sugar that's in it, it is a little bit deeper. And so we want to give you the context around all of those things so you can figure out where you are with food and your relationship. And the idea of the meal mix and the balance, but in no way, shape or form are we saying eliminate sugar. And the only kind of medical reason that I could think of is if there's a true, it's a very rare, true sugar allergy. And there's a medical necessity reason where that is harmful to your body. Even with diabetes, you can find a workable and flexible way to have foods with sugar and with added sugar, and still have a great positive happy life and still care for yourself with diabetes. And that's the bottom line there.

Glenys Oyston, RDN: 17:41

Absolutely. We're going to come to our last myth now. I like this one because I feel like it comes up a lot, and it translates into guilt for people. But this idea that once you have a diagnosis of pre-diabetes, or diabetes, that you really should only ever eat whole, unprocessed grains or minimally processed grains for health. And I think what I'm seeing is that it translates into this guilt message for people like if I'm eating anything other than whole grains, I'm doing something wrong. So what do you think about this myth and why it persists?

Rebecca Scritchfield, RDN: 18:20

Mm hmm. You know, I think that we accidentally get stuck on this. You know that traffic light? Red light, yellow light, green light. That horrible traffic light around you. Or good food, bad food, you know, and again, it's a very simple binary way of thinking, and we ask folks to be really flexible about, you know, it might be easier cognitively. What's the best? This and that. And I would challenge you, what is best mean to you, and are you putting preferences in there? So, I can tell you when weather is warmer, I like colder foods, right? And so, there's this really awesome quinoa tabbouleh recipe that I found years ago. It's really easy to make, it's great to make on a Sunday and my lunches are so simple, I change out the protein. It's an easy, delicious choice. But I'm not sitting here going quinoa is superior, it has all this protein and these minerals, and it's way better than white rice. You know, I actually really, really love white rice and have that way more often than brown rice. Again, it goes around in a preference wise and there could be culturally meaningful reasons to why you might like your carbohydrate foods that are not unprocessed or not in a package.

Rebecca Scritchfield, RDN: 19:48

I think the idea is, if you're hearing those concerns from someone else, say, you know what, that's actually not really true for me. I can be flexible, my eating patterns matter. Find what's going to work for you. That's something that we really, really care about when we do our live groups, that we help people find what it is specific to them that would really be helpful. And it's not always the same, but if that is a way you could kind of sift through that, but then when it's for you and you're thinking about a preference, ask yourself, is this a fear? Am I responding to a fear? Or a myth? That good, better, best with food? Am I ignoring preferences? Am I ignoring personally meaningful cultural attachments to my food? You really want to challenge yourself and where that comes from. Scientifically, it can't be proven, but our culture will say: good, better, best. And, we just need to have a little bit of doubt, I feel like with that, and really encourage yourself that, hey, if I like the taste and preference with these whole grains, yep, I know about nutrition, they're going to have more fiber, they've got some good nutrients. There is a lot of pleasure and satisfaction and nourishment, even with what somebody would compare as a lesser than, like a refined grain. And so, get yourself out of that comparison, in that sort of absolute way, consider a bigger picture, your preferences, your overall eating patterns. Heck, I would argue when you're being active, that that's a great time pre-exercise to have something with some added sugar in it, that's a great time to have some refined grains. You're going to have a more enjoyable workout, you're going to have the sugar, glucose energy that you need to get through that workout as well. Sometimes we can find this positive function to these things that we believe are less good for us. So yeah, that's where I would love to leave that myth. Throughout where we've been talking, it really has been, you really need to look at the bigger picture, you really need to take a broader view. What do you think Glenys?

Glenys Oyston, RDN: 22:00

Yeah, and I think, the reality is, there's benefits to both right? There's all the fiber and all the nutrients that are left in the whole grain, we do enrich white flour in this country. But when I think about those sort of refined grain products, what I think about is the pleasure principle, right? Like we said earlier, those foods exist, and so thinking about how you still want those to be in your world. And I think if you have that flexibility, then you can also have the curiosity to explore those other things, versus feeling like I can only ever eat whole grains. And I think, again, sort of that should thinking just closes down the pleasure in eating. So, I think having flexibility to say I can have refined grains too, I think it allows the curiosity to bloom around exploring whole grains if that's a value for you.

Rebecca Scritchfield, RDN: 22:58

Right. And some of the other podcasts that we have, we have one specifically focused on blood sugar. So if you're looking for something that's personal around what to do about blood sugars you can listen to our podcast. If you join our group, we're going to support you there with lots of tools and resources, plus the live support that we offer. And if you're dealing with, I don't deserve pleasure because I have diabetes, maybe you've told yourself your whole life you don't deserve pleasure, that is going to be an issue around shame, diagnosis, shame and that was a really important episode that we did, as well. It's a super important topic that we cover and are consistently reminding our members of, about worthiness and deserving and resilience to shame, because it can have such a deep impact on our thoughts, feelings, and then our behavior. So hopefully, now we have less confusion because a lot of it is be flexible and do what you love, and things matter. But it's not going to be simple rules base of do's and don'ts. That stuff, if it's getting you in trouble, if it's creating fear and anxiety, we are here for you because that doesn't work for us either. We don't want you to sort of suffer unnecessarily anymore with unhelpful rules and fear that's making you afraid to even take the first positive step in caring for yourself with diabetes.

Glenys Oyston, RDN: 24:17

Yeah, I'm glad we were able to talk about this today.

Rebecca Scritchfield, RDN: 24:20

Yeah, thanks for coming on and chatting.

Glenys Oyston, RDN: 24:22

Thank you for having me.

Rebecca Scritchfield, RDN: 24:27

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